The study also examined variations in enrollment in these plans across geographic areas and nursing homes. Nursing homes with residents enrolled in MMPs, FIDE SNPs, and I-SNPs were generally larger facilities and located in metropolitan areas with higher Medicare Advantage penetration. 76% of enrollments occur in only 16% of US counties.
“Dual-eligible beneficiaries have insurance through two distinct and uncoordinated programs: Medicaid, which pays for long-term care; and Medicare, which pays for medical care, including hospital stays. Concern that this system leads to poor quality and inefficient care, particularly for dual-eligible nursing home residents, has led policy makers to test managed care plans that provide incentives for coordinating care across Medicare and Medicaid. We examined enrollment in three such plans among dual-eligible beneficiaries receiving long-term nursing home care. Two of those plans, Medicare-Medicaid plans and Fully Integrated Dual Eligible Special Needs Plans, are integrated care plans that establish a global budget including Medicare and Medicaid spending. The third, Institutional Special Needs Plans, puts insurers and nursing homes at risk for Medicare spending but not Medicaid spending. Among dual-eligible nursing home residents, enrollment in these plans increased from 6.5 percent of residents per month in 2013 to 16.9 percent in 2020. Enrollment varied across counties but did not vary appreciably with respect to nursing home characteristics, including the share of residents with Medicaid. As policy makers pursue strategies to coordinate medical and long-term care for dual-eligible beneficiaries, it remains critical to evaluate how these plans influence the care of dual-eligible nursing home residents.”
Roberts, E. T., Chen, X., Macneal, E., & Werner, R. M. (2024). Dual-Eligible Nursing home Residents: Enrollment growth in managed care plans that coordinate care, 2013–20. Health Affairs, 43(9), 1296–1305. https://doi.org/10.1377/hlthaff.2023.01579
Meline, M. (2024, November 12). Enrollment Grows in Integrated Managed Care Plans for Dual-Eligible Nursing Home Residents – Penn LDI. Penn LDI. https://ldi.upenn.edu/our-work/research-updates/enrollment-grows-in-integrated-managed-care-plans-for-dual-eligible-nursing-home-residents/
O’Connor, J. (2024, October 10). I-SNPs quadrupled growth through 2021, but large swaths of nursing home residents still without any access. McKnight’s Long-Term Care News. https://www.mcknights.com/news/i-snps-quadrupled-growth-through-2021-but-large-swaths-of-nursing-home-residents-still-without-any-access/
Improve Medicare Advantage reimbursements with payer contract management that puts payer rules in the hands of clinicians & billers.
